Used by
23,000+ clinicians

Adaptive Learning: A Better Way to Teach and Help Residents Pass their Boards

Today's residents are faced with learning a vast amount of information that is growing exponentially in size and velocity. Textbooks with lengthy chapters, and even many e-learning programs, are no longer adequate for imparting and instilling the latest evidence-based knowledge, which is expanding faster than residents' ability to assimilate and apply it effectively.1

It is estimated that the doubling time of medical knowledge in 1950 was 50 years; in 1980, 7 years; and in 2010, 3.5 years. In 2020 it is projected to be 0.2 years—just 73 days.2

Traditional learning techniques – including most e-learning programs – can't keep up with the complexity and volume of medical knowledge that today’s physicians must absorb and apply. That is why, to avoid education burnout, many residency program directors are turning to advanced adaptive learning programs to help their residents learn more efficiently.

Did You Know?

What students learn in the first three years of medical school will be just six percent of what is known by 2020.3

What is Adaptive Learning?

What is Adaptive Learning?

The move to adaptive learning is a fundamental change in how medical educators approach curriculum4 and is based on evidence that each learner has his or her own learning needs and often achieves competency at a different rate than others.5

Adaptive learning technology provides an individualized learning experience that starts by determining a learner's strengths and weaknesses and then uses powerful algorithms to serve information and learning exercises that address the learner's limitations, guiding them to greater proficiency and understanding, making the learning process both more effective and efficient.

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Why Choose NEJM Knowledge+ for Adaptive Learning?

Few tools, even among digital learning platforms, utilize the breadth of principles addressed in true adaptive learning in their pedagogic design. NEJM Knowledge+ is an exception.

NEJM Knowledge+ was designed from the ground up to combine a comprehensive adaptive learning engine with ABMS board-blueprint-driven cases, questions, and detailed feedback — all developed by experts specifically for efficient and effective board review. Its unrivaled ability to identify areas of knowledge weakness and strength and adjust the learning pathway in real time, to improve both knowledge and metacognition, helps residents improve their clinical decision-making accuracy.

NEJM Knowledge+ meets each resident precisely where they are in their learning journey. It tests a resident's current level of knowledge by presenting the most relevant and critical information and instantly assesses their understanding based on 100+ algorithmic variables including response time and reported level of confidence. Then, NEJM Knowledge+ presents needed information in a variety of question formats – cases, multiple-choice questions, and fill-in-the-blank questions – to reinforce and test mastery of the material.

Sophisticated algorithm assesses learners' performance and confidence in their knowledge.

Real-time, detailed feedback motivates residents and facilitates autonomous, self-directed learning.

“Recharge” serves information that learners are most likely to have forgotten. 

A variety of question formats helps reinforce residents’ understanding.

Reporting, tracking, and custom quizzes help educators assess residents' knowledge and identify focus areas for coaching and remediation.

In resident education, a one-size-fits-all curriculum doesn't fit everyone. In fact, it may fit no one. Adaptive learning with NEJM Knowledge+ is the better option for today's residents who are faced with a constantly evolving and growing body of medical knowledge. It helps them excel on exams, boost their confidence and understanding, and set the stage for lifelong learning.

Not all adaptive learning programs are the same. Learn how they are different

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Residents & Medical Educators Say

Residency Programs Around the
World Use NEJM Knowledge+ Including:

Adaptive Learning for 21st Century Residents: Insights and Best Practices

Read how your colleagues are incorporating adaptive learning into their residency education programs.

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AAP National Conference & Exhibition

October 25-29

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November 1-3

Lancaster, PA

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February 27-29

San Diego, CA

NEJM Knowledge+ is a product of NEJM Group, a division of the Massachusetts Medical Society.

"NEJM Knowledge+ has been a positive step for our program and reflects our commitment to residents' success. The powerful thing about NEJM Knowledge+ is the way it can track what residents are working on, how far they have gone, how much time they're spending and where they are. It also tracks residents who need help. It gives us a better way of capturing real-time data, lets us create substantial reading plans for our residents, and hold residents accountable."

Louis Miller

Louis Miller, MD

Former Senior Associate Program Director

NYU School of Medicine

"The residents of today are incredibly technologically savvy. They want point of care resources.They want quick deliverables and key clinical ‘pearls’, as opposed to being able to go back and sit in a book and read a chapter, or even read parts of an online discourse or didactic."

Dr. Divatia

Dr. Divatia

DO, FACP, FAAP; Associate Program Director, Internal Medicine-Pediatrics Residency Program

Care Health System/Sidney Kimmel Medical College at Thomas Jefferson University

"NEJM Knowledge+ is helpful because the cases are clinically based and come in smaller chunks so residents can retain it. The technology is attractive and more user-friendly, and we can actually track resident progress. The comfort level of whether or not they know what they don't know is quite interesting, and the spaced repetition is extremely helpful."

Ning-Zi Sun

Ning-Zi Sun

MDCM, MHPE, FRCPC, Assistant Program Director, McGill Internal Medicine Residency Program

"We try to stay ahead of the curve in revising our GME curricula. We initially chose NEJM Knowledge+ to help us hold residents accountable for doing practice-forward exam questions and track their progress. It fosters residents' ability to assess what they need to do to learn, and response from faculty has been good because it has provided more structure to resident coaching and gives us better insight into what our residents are doing. It lets us partner with residents to create individualized learning plans"

Rebecca Miller

Rebecca Miller, MD

Associate Program Director, Virginia Commonwealth University

"I really like the adaptive learning format. The way the questions change each time they are asked reinforces everything. The software is fun to use…I love the interface."

Jeremy Ross

Jeremy Ross, MD

"I use it to keep up with the latest information on different topics. This kind of learning makes a lasting impression and helps me apply the learning in clinical situations."

Chen Pu Yeh

Chen Pu Yeh, MD

"NEJM Knowledge+ allows the user to be free of the need to plan his or her next learning subjects."

Amir Agamil

Amir Agamil, MD

"Its portability [makes] a rich question bank available on hand-held devices [for] accessibility wherever I am."

Branislav Zagrapan

Branislav Zagrapan,MD

"I appreciate having a variety of question formats – long and short – both with great explanations."

Thomas Kessler

Thomas Kessler, MD

""The quality of the questions is amazing."

Fredrik Holmberg

Fredrik Holmberg, MD

What specialty areas do your board review products cover?

We currently have products for internal medicine, med-peds, pediatrics, family medicine, and PA training programs. In addition, many transitional and preliminary programs subscribe to NEJM Knowledge+.

What is the cost for institutional/group purchases?

As a not-for-profit, mission-driven medical organization, we make NEJM Knowledge+ available to residency programs at rates dramatically discounted from the individual pricing (up to 45%). Terms are typically one year; however, we can tailor proposals to fit your unique needs and budget challenges.

Do you have proof that using NEJM Knowledge+ increases trainees’ likelihood of passing the board exam?

Yes, in a soon to be published independent study conducted by ABIM, research found that learners with 75% progress in NEJM Knowledge+ were significantly more likely than rigorously matched controls to pass their board exam and to score in the top quartile.

Can faculty use the question bank to create quizzes, pre/post rotation exams, and/or tests for didactic lectures? Is there an additional cost?

Yes, NEJM Knowledge+ can save your faculty time and effort by allowing them to create quizzes for the learners, both individually or as a class/program. Full reporting is available for each quiz created and assigned. This unique feature is included the program’s annual institutional subscription.

Will I be able to track my trainees’ progress and their areas of strength and weakness?

Yes, the institutional/group purchase allows for program administrators to track each learner’s progress and proficiency in each subspecialty and overall. Program-level reporting allows program directors and faculty to view the progress and performance of all their trainees. NEJM Knowledge+ program reporting includes:
  • Usage by individual
  • Most challenging learning objectives
  • Progress in each specialty and topic
  • Practice exam performance
  • Metacognition (confidence vs. performance)
  • Reports by post-graduate year
  • Performance by learning objective
  • Quiz performance

Is there an app for your product?

Yes, both Android and iOS apps are available for smartphones and tablets. This product was designed with the current generation of learners in mind. Knowing that millennial residents are digital natives, we made sure to create an intuitive, user friendly, engaging app to help facilitate their learning and retention.

All of your competitors say they are adaptive — what makes your platform unique?

Although many learning systems may call their platforms adaptive, they fall short of a truly personalized experience. Using the latest advancements in neuroscience, the NEJM Knowledge+ platform meets each resident precisely where they are in their learning process. It tests a resident's current level of knowledge by presenting the most relevant and critical information and instantly assessing their understanding based on 100+ algorithmic variables including response time and reported level of confidence. Then, NEJM Knowledge+ focuses on individual knowledge gaps, presenting clinical concepts in a variety of case-based question formats – such as long-form, short-form and multiple choice – to reinforce and test mastery of the material. No two residents have the exact same learning experience.

Do you offer short-term subscriptions?

Yes, for group/institutional subscriptions, we can tailor the term of the subscription to meet your needs — please contact us for a personalized quotation.

Frequently Asked Questions

  1.  Dimock M. Defining Generations: Where Millennials end and Generation Z begins. Pew Research Center. January 17, 2019.http://www.pewresearch.org/fact-tank/2019/01/17/where-millennials-end-and-generation-z-begins/
  2. Annamalai V. Bridging the Generation Gap in Healthcare Education: Understanding Millennial Learners. https://www.ahme.org/wp-content/uploads/2018/06/F17_Bridging-the-Generation-Gap-in-Medical-Education-Understanding-the-Millennial-Learner_Annamalai_Fri-05-18-18_Highland-1-2.pdf
  3. Nasca TJ et al. The next GME accreditation system-rationale and benefits. N Engl J Med 2012;366(11): 1051-6.
  4.  Sharma N et al. Adaptive learning in medical education: the final piece of technology enhanced learning? Ulster Med J 2017;86(3):198-200.
  5. Jiang J. Millennials stand out for their technology use, but older generations also embrace digital life. Pew Research Center. May 2, 2018. http://www.pewresearch.org/fact-tank/2018/05/02/millennials-stand-out-for-their-technology-use-but-older-generations-also-embrace-digital-life/
  6. 2018 State of Attention. Prezi https://prezi.com/resources/2018-state-of-attention-report/ 
  7. Miller, GA. The magical number seven, plus or minus two: Some limits on our capacity for processing information. Psychol. Rev. 63:81-97.
  8.  Sweller J et al. Cognitive architecture and instructional design. Educ Psychol Rev 1998 Sep; 10:251-296. 
  9.  Souza, MIF and do Amaral SF. Educational microcontent for mobile learning environments. Creative Education 2014 May; 5:672-681  
  10. Hug T. Mobile learning as 'microlearning': conceptual considerations towards enhancements of didactic thinking. In: Parsons D, editor. Refining current practices in mobile and blended learning: new applications. Hershey: IGI Global 2012. http://www.irma-international.org/viewtitle/49678/ 
  11. Murre JMJ and Dros J. Replication and analysis of Ebbinghaus' forgetting curve. PLoS One 2015 Jul 6; 10:e0120644 
  12. Akresh-Gonzales J. Spaced repetition: the most effective way to learn. https://knowledgeplus.nejm.org/blog/spaced-repetition-the-most-effective-way-to-learn/ NEJM Knowledge+. Nov 19, 2015. 
  13.  Annamalai V. Bridging the generation gap in healthcare education: understanding millennial learners. Dell Medical School, University of Texas at Austin Jun 2018. https://www.ahme.org/wp-content/uploads/2018/06/F17_Bridging-the-Generation-Gap-in-Medical-Education-Understanding-the-Millennial-Learner_Annamalai_Fri-05-18-18_Highland-1-2.pdf 
  14. [xiii] NEJM Knowledge+. What Is the Testing Effect and How Does it Affect Learning, Knowledge, and Retention? 
  15. Lajoie SP and Gube M. Adaptive expertise in medical education: accelerating learning trajectories by fostering self-regulated learning. Medical Teacher 2018 Aug; 40(8):809-812.  
  16. Aho JM et al. Mentor-guided self-directed learning affects resident practice. J Surg 2015 Jul-Aug; 72(4):674-679 
  17. Peacock A. Engage millennial employees with feedback and evaluation. Clutch Dec 7, 2016 https://clutch.co/hr/resources/engage-millennial-employees-feedback-evaluation 
  18. Harden RM et al. Forty years of medical education through the eyes of Medical Teacher: from chrysalis to butterfly. Medical Teacher 2018 Apr; 40(4):328-330.
  19.  Annamalai V. Bridging the Generation Gap in Healthcare Education: Understanding Millennial Learners https://www.ahme.org/wp-content/uploads/2018/06/F17_Bridging-the-Generation-Gap-in-Medical-Education-Understanding-the-Millennial-Learner_Annamalai_Fri-05-18-18_Highland-1-2.pdf 
  20.  Price, C. Why don't my students think I'm groovy? The new “R”s for engaging millennial learners. The Teaching Professor 2009.
  21. Cox M et al. Assessment in medical education. N Engl J Med. 2007 Jan 25; 356(4):387-396.
  22. Desy JR et al. Milestones and millennials: a perfect pairing—competency-based medical education and the learning preferences of Generation Y. Mayo Clin Proc 2017 Feb;92(2):243-250.

What specialty areas do your board review products cover?

We currently have products for internal medicine, med-peds, pediatrics, family medicine, and PA training programs. In addition, many transitional and preliminary programs subscribe to NEJM Knowledge+.

What is the cost for institutional/group purchases?

As a not-for-profit, mission-driven medical organization, we make NEJM Knowledge+ available to residency programs at rates dramatically discounted from the individual pricing (up to 45%). Terms are typically one year; however, we can tailor proposals to fit your unique needs and budget challenges.

Do you have proof that using NEJM Knowledge+ increases trainees’ likelihood of passing the board exam?

Yes, in a soon to be published independent study conducted by ABIM, research found that learners with 75% progress in NEJM Knowledge+ were significantly more likely than rigorously matched controls to pass their board exam and to score in the top quartile.

Can faculty use the question bank to create quizzes, pre/post rotation exams, and/or tests for didactic lectures? Is there an additional cost?

Yes, NEJM Knowledge+ can save your faculty time and effort by allowing them to create quizzes for the learners, both individually or as a class/program. Full reporting is available for each quiz created and assigned. This unique feature is included the program’s annual institutional subscription.

Will I be able to track my trainees’ progress and their areas of strength and weakness?

Yes, the institutional/group purchase allows for program administrators to track each learner’s progress and proficiency in each subspecialty and overall. Program-level reporting allows program directors and faculty to view the progress and performance of all their trainees. NEJM Knowledge+ program reporting includes:
  • Usage by individual
  • Most challenging learning objectives
  • Progress in each specialty and topic
  • Practice exam performance
  • Metacognition (confidence vs. performance)
  • Reports by post-graduate year
  • Performance by learning objective
  • Quiz performance

Is there an app for your product?

Yes, both Android and iOS apps are available for smartphones and tablets. This product was designed with the current generation of learners in mind. Knowing that millennial residents are digital natives, we made sure to create an intuitive, user friendly, engaging app to help facilitate their learning and retention.

All of your competitors say they are adaptive — what makes your platform unique?

Although many learning systems may call their platforms adaptive, they fall short of a truly personalized experience. Using the latest advancements in neuroscience, the NEJM Knowledge+ platform meets each resident precisely where they are in their learning process. It tests a resident's current level of knowledge by presenting the most relevant and critical information and instantly assessing their understanding based on 100+ algorithmic variables including response time and reported level of confidence. Then, NEJM Knowledge+ focuses on individual knowledge gaps, presenting clinical concepts in a variety of case-based question formats – such as long-form, short-form and multiple choice – to reinforce and test mastery of the material. No two residents have the exact same learning experience.

Do you offer short-term subscriptions?

Yes, for group/institutional subscriptions, we can tailor the term of the subscription to meet your needs — please contact us for a personalized quotation.
  1. Densen P. Challenges and opportunities facing medical education. Trans Am Clin Climatol Assoc. 2011;122:48-58
  2. Densen P. Challenges and opportunities facing medical education. Trans Am Clin Climatol Assoc. 2011;122:48-58
  3. Densen P. Challenges and opportunities facing medical education. Trans Am Clin Climatol Assoc. 2011;122:48-58
  4. Harden RM, Lilley P, McLaughlin J. Forty years of medical education through the eyes of Medical Teacher: From Chrysalis to Butterfly. Medical Teacher 2018;40(4):328-33
  5. Sharma N, Doherty I, Dong C. Adaptive Learning in Medical Education: The Final Piece of Technology Enhanced Learning? Ulster Med J 2017;86(3):198-200.

True adaptive learning programs deploy sophisticated algorithms that mimic the way viruses behave in nature, continuously evolving, moment by moment. They are based on the theory that learning works chaotically and there are many pathways to achieving the same learning objective. Moreover, adaptive learning programs allow learners to make mistakes – and learn from them – just as in real-world cognitive situations. As a result, residents develop their critical thinking skills, enabling them to respond more effectively in clinical situations.

Want to know more? Check out this brief video

Adaptive Learning for 21st Century Residents: Insights and Best Practices

NEJM Knowledge+ was engineered to apply robust adaptive learning science to the higher-level objectives and complexities of medical education.

Download Whitepaper

Read how residency programs use adaptive learning to absorb a high volume of complex medical knowledge

No other adaptive learning program engages residents like NEJM Knowledge+:

Traditional Learning

The same for everyone.

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Exposes content first, then assessment.

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Ignores what the student already knows.

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Starts from the beginning. Progresses linearly every time.

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Adaptive Learning

Adapts to the individual.

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Assesses first, then exposes targeted content when necessary. 

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Takes into consideration what the student already knows. Focuses on knowledge gaps. 

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Self-directed. Follows up on what the learner is having trouble with. 

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